The Efficiency of Additional Fixation of the Alternative Bone Substitute in Unstable Intertrochanteric Fractures of Femur Treated with Gamma Nail

Jong-Oh Kim; Young-One Ko; Mi-Hyun Song

doi:10.12671/jkfs.2011.24.1.1

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Kim, Ko, and Song: The Efficiency of Additional Fixation of the Alternative Bone Substitute in Unstable Intertrochanteric Fractures of Femur Treated with Gamma Nail

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2011; 24(1): 1-6.

Published online: 19 January 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.1.1

The Efficiency of Additional Fixation of the Alternative Bone Substitute in Unstable Intertrochanteric Fractures of Femur Treated with Gamma Nail

Jong-Oh Kim, M.D., Young-One Ko, M.D., Mi-Hyun Song, M.D.

Department of Orthopedic Surgery, Mokdong Hospital, Ewha Woman's University School of Medicine, Seoul, Korea.

Address reprint requests to: Jong-Oh Kim, M.D. Department of Orthopedic Surgery, Mokdong Hospital, Ewha Woman's University School of medicine, 911-1, Mok-dong, Yangcheon-gu, Seoul 158-710, Korea. Tel: 82-2-2650-5276·Fax: 82-2-2642-0349, ewhamdos@korea.com

Received 24 July 2010 Revised 29 October 2010 Accepted 10 November 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficiency of additional fixation of the alternative bone substitute in unstable intertrochanteric fractures treated with gamma nail and alternative bone substitute and only with gamma nail.

Materials and Methods

Radiologic comparison was done between forty-four patients of unstable intertrochanteric fracture (AO type A2.2, A2.3) during six months. The patients were divided into two groups, a group treated with gamma nail and alternative bone substitute (22 patients, group 1) and another group treated only with gamma nail (22 patients, group 2). Postoperative reduction status, Cleveland index, Tip-apex distance and complications during the follow-up period was compared. Lag screw slippage and femoral neck-shaft angle change were measured between two groups.

Results

No significant difference of reduction status, Cleveland index and Tip-apex distance was found. In group II, there was a 1 more case of cutting-out of the lag screw, but also there was a significant difference. Lesser change in lag screw slippage and neck-shaft angle change was investigated.

Conclusion

As there are lesser lag screw slippage and neck-shaft angle change, alternative bone substitutes applied in unstable intertrochanteric fractures seems to be useful in maintaining reduction and preventing failure of internal fixation when proper reduction and screw insertion is performed.

Keywords: Unstable intertrochanteric fracture, Gamma nail, Alternative bone substitute

Figures and Tables

Fig. 1

Injection of PolyBone.

(A) Applying the specially manufactured guide and the pusher for insertion of PolyBone.

(B) Injection of PolyBone into the guide and pushing to the lag screw insertion area by pusher.

(C) C-arm radiograph after PolyBone injection to lag screw insertion site.

Fig. 2

Result of Cleveland index.

(A) Result of Group I^* - 20 of 22 patients (90.0%) inserted the lag screw in zone 5, 6, 8, 9.

(B) Result of Group II^† - 19 of 22 patients (86.3%) inserted the lag screw in zone 5, 6, 8, 9.

^*Group I: Fixation with gamma nail and PolyBone, ^†Group II: Fixation only with gamma nail.

Fig. 3

Result of neck shaft angle change and lag screw slippage.

(A) Lesser change in femoral neck shaft angle is checked during 6 months in group I (p<0.001).

(B) Also, there is lesser change in lag screw slippage during follow-up term in group I (p<0.001).

Table 1

Details of both treatment groups

^*Group I: Fixation with gamma nail and PolyBone, ^†Group II: Fixation only with gamma nail.

Table 2

Classification of reduction (from Fogagnolo et al.9))

Table 3

Immediate postoperative reduction status

^*Group I: Fixation with gamma nail and PolyBone, ^†Group II: Fixation only with gamma nail.

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